Friday, March 11, 2011

Home Health Therapy Coverage Requirements: CMS Fact Sheet Available

In anticipation of the new home health therapy coverage requirements that will go into effect April 1, the Centers for Medicare and Medicaid Services (CMS) has posted a Therapy Requirements Fact Sheet on its Web site to aid physical therapists and home health agencies as they seek to implement these policies. CMS indicates that more detailed language will be available in the coming weeks as it plans to release changes to the home health provisions contained in the Medicare Benefits Policy Manual (Pub 100-02, Chapter 7).

Comments

looking for home health seminars...recommendations??

Posted by Corinna Baffa
on 3/24/2011 1:11 AM

The new Medicare rules for 13th and 19th visit reassessments needs some improvement. I would like the APTA to propose to CMS that when 3 therapy disciplines are active for a patient, reassessment is only required prior to the 19th visit, not 14th and 19th. I have had a CVA patient in which ST and OT were also in and I was forced to do reassessments on two consecutive PT visits. I saw the patient on the 13th visit. The OT the 14th, ST the 15th, and I had to do one on the 16th visit or I would not have made it back by the 19th visit. This rule creates potential for disruption of services with 3 disciplines.

Posted by keith bisesi
on 4/30/2011 12:39 AM

Reassessment every 30 days, 13th and 19th visit of all therapy services, after hospitalizations (even if for a day), at the end of MD orders (which may be for only 1 to 2 weeks, after all incidents. Ole McDonald had a farm ei ei oh, with an assessment here and an assessment there, here assessment, there assessment, everywhere an assessment assessment. In an effort to save money Uncle Sam is shooting himself in the foot by providing less treatment time to the pt. and more nonproductive time on paper work.

Posted by Bruce Gaines
on 7/16/2011 9:07 AM

Had something come up in my office. Did a PT evaluation in old cert period, but that cert period was about to run up. They calculated my 30th from the first PTA visit in the new cert period, but I figured it should be from my first assessment. A little confusing????

Posted by Nikki Snelgrove
on 9/6/2011 8:08 PM

HHA

Posted by SAHENDY
on 10/24/2011 10:37 PM

Do I really need to reassess on the 13th visit if the 30 day reassessment falls on the 12th visit?

Posted by Julie Timberlake
on 11/12/2011 12:32 PM

Yes. You have to reassess again on the 13th visit if the 30 day reassessment falls on the 12 visit.

Posted by keith bisesi
on 2/1/2012 10:13 PM

Nikki, that is incorrect. The reassesment for the 30th day is based on the last time you performed and initial assessment or reassessment, not at all based on the first day of the new cer period, nor the first PT visit in the new cert period. A better example, if you recerted a patient 4 days before the end of a cert period, the 30 day reassessment is from the day the recertification was rendered, not the first day of the new cert period.

Posted by keith bisesi
on 2/1/2012 10:17 PM

I agree that cms make this requirement and we have to fallow but require another pease of paper when the require more time for the therapist and less time for the patient why we are no focus first on taking care our patient I am physical therapy on the home and I always reasses my patient every visit because we have to see the changes on our patient but assessment and assessment 30 13 19 enough is enough let treat our patient and provide the documentation that justified why we see our patients I.

Posted by Francisco caballero
on 10/21/2012 4:02 PM

Hello everyone! My name is Adrian, and I am the DON of Aspen HH Care in Chicago, IL. I got a question regarding the mandatory 30-day re-eval per PT. Can anybody HELP CLARIFY the following:
1-Our HH agency is using contracted PT services
2-The contracted PT agency uses RPT's & PTA's
3-One of their RPT did an INITIAL EVAL on 6/27/12
4-Same RPT did a PTA supervisory visit on 7/16/12 which is day 19 from the initial Eval
5-The RPT also used this day-19 PT visit as a day-30 PT RE-Eval
6-Other 3 PTA visits were made afterwards, on 7/18,7/23 & 7/25, which count for day 21,26,28 respectively from the Initial Eval
7-The RPT insists that the day-30 re-assessment can be done ANYTIME within the 30 day from the Initial Eval, including day 19 from Init.Eval
8-Our Agency believes that the 30-Day re-assmt should be done AS CLOSE AS POSSIBLE to the 30-th day from the Init.Eval, in our case NOT SOONER THAN 7/25, which is day 28.
Can anybody help us clarify the above? Is there any guideline in this regards? Can you provide me a specific article in CMS regulation on this? Please reply ON THIS PAGE, or on our agency's email: aspenhealthsystem@yahoo.com
THANK YOU VERY MUCH FOR A QUICK REPLY.
--3+

Posted by ADRIAN
on 11/1/2012 4:46 PM

Hey Adrian, the definition of the 30 day reassessment rule is for a reassessment to be performed "at least every 30 days". Each time a reassessment visit happends the 30 day clock resets. So the PT can perfrom the 30 day reassessment anytime during the 30 day period. Example lets say a Pts POC was 5w2,3w2. They would hit the 13th visit reassessment requirement before the 30 day requirement. Once the 13th visit is performed, the 30 day requirment resets. Hope it helps

Posted by Chad
on 11/28/2012 5:35 PM

If a PT conducted at 13th visit/30 day reassessment (PT only patient), but had a missed visit because of patient request, but, the PT conducted the 13th visit/30 day reassessment on the actual 32nd day, is that still reimburseable?

Can you perform a re-assessment on every visit in order to prevent missing the 13, 19, and 30day? While i have found nothing that directly states you can. I have located a note from CMS stating that:
If the measurement results do not reveal progress toward
therapy goals and/or do not indicate that therapy is effective,
but therapy continues, the qualified therapist(s) must
document why the physician and therapist have determined
therapy should be continued.
Therefore, if we are performing a reassessment on every visit and not noting progress from previous one, we stand to risk licensure for providing a service that is not documented as necessary.
Thought?

Posted by Enon
on 12/10/2013 11:04 PM

I have a question that I cannot get answered - if a homecare patient is ordered for "PT only" but the PT goes & feels for whatever reason the patient needs a nurse, and calls the MD and gets the RN order, the PT would then open or admit the patient, but the visit is not "billable" because the RN comes in the next day & does the OASIS. In that first visit the PT did their eval. Does that first visit "count"? Or does the PT do a reassessment on the second visit and have the count start from there since the first visit is "non covered". How do others handle this?

Posted by Jen
on 1/9/2014 8:43 PM

Jen: Why didn't PT just do a PT SOC and complete the OASIS, making that a billable visit? Order for RN occurred after SOC, so RN would just do SN evaluation anyway. I am not seeing why the first visit would be "non covered" at all. RN only has to do the SOC if both are ordered on the initial referral, not if RN is an ancillary service ordered after the case is open.

Posted by Juli
on 1/25/2014 11:45 PM

I would like to ask, can the OT do the evaluation first prior to PT after the RN did the SOC (OASIS C). I would like a clarification, because per inquiries to different people who works in HHA and therapists as well, they said OT can go first if OT able to set appointment earlier but OT can not do OASIS-C Start of care but can do dc OASIS. I remember that my DON/ owner said that NO but she called one of her HHA friend and said yes. But now, it is No again. I do not know how to dealt with this kind of No yes No yes issue, I am just an employee and she is the owner. I have no rights to argue.
It is really complicating me if people changes and don't remember what they were talking before. I probably have a written or recorded conversation to avoid confusion.

Posted by Lee
on 12/4/2014 11:34 AM

i have a question..I am a PT and work in home health. Can PT eval the patient before the nurse admits ON THE SAME DAY?? thanks